Who can prescribe medicine for OCD?

Hi, I have a question. I was just diagnosed this past year with ocd by my marriage and family therapist intern who's being supervised by a licensed marriage and family therapist. And I know she can't prescribe medicine but I am wondering since I have been working so hard on my ocd and nothing seems to help calm my symptoms and I've read about how higher doseages of antidepressants can help calm the symptoms down I was wondering who would be able to prescribe that for me?

[ChristianWolff]

Christine,

As I understand it, in order to prescribe medications the practitioner must be an M.D. such as a psychologist or your primary care physician as opposed to a PhD of a therapist.

[Selesnya]

There are a number of qualifications for people to be able to write prescriptions. Your primary care physician can write prescriptions, but they may not have the expertise to really know the various options in detail. It is probably better to end up with a psychiatrist or equivalent. You might end up with someone that has an MD license, or it could be some variety of nurse or something else. The catch-all term is prescriber, since there are a number of roles that can do this.

If you can end up with a therapist that specializes in treating OCD, they may have some input to give to the prescriber and they will probably know the options better than you do.

[BethIOCDF Partner IOCDF Staff]

Hello ChristineJarvis27,

Only psychiatrist can prescribe medication for OCD because they are medical doctors (med school, residency etc..). Psychologists, however, do not prescribe medication. If you are looking for a psychiatrist in your area, please use our resource directory on our website iocdf.org. Or email us at [e-mail]. Hope this was helpful.

[ChristianWolff in reply to BethIOCDF]

My bad, of course you are correct Beth.

[NovaOllie in reply to BethIOCDF]

A person diagnosed with OCD typically gets their medication from a psychiatrist, however any licensed medical doctor (MD) could prescribe medications if necessary. I don't believe it is true that the MD has to be a licensed psychiatrist. Please correct me if I am wrong.

[BethIOCDF Partner IOCDF Staff in reply to NovaOllie]

Yes, you are correct. An MD can prescribe OCD medication. However, the ideal would be to get medication from an experienced medical professional in the field of mental health.

[Hidden]

What about a regular physician?

[Selesnya in reply to Hidden]

Yes, they can prescribe medication, but they may be more helpful with longer-term maintenance instead of figuring out what works best initially.

[Hidden]

So could I have my counselor or her supervisor tell me which medication would be the best for my ocd and talk to my doctor about it my next appointment?

[Selesnya in reply to Hidden]

The counselor is likely to say that they can't recommend medications. This sounds like a conversation to have with your doctor, but they may say that they aren't comfortable prescribing meds for OCD and recommend you to a psychiatrist.

I know that my primary care doctor was happy to take over my meds once they were just on maintenance, but he did not want to be making changes with the prescriptions and figuring out what would work best for me initially.

[Wheeloffortune in reply to Selesnya]

You are really good at giving counsel!! Have you ever thought of becoming a counselor or peer support advocate?? I always like what you have to say!!

[Selesnya in reply to Wheeloffortune]

Once I'm doing better with OCD for a sustained period, I think that would be a more interesting and rewarding thing that what I'm doing right now. However, that would mean that I'd have to tell people (like my parents) that I have OCD. That's too big of a hurdle for me right now.

[Hidden in reply to Selesnya]

Ok thank you for your advice. I have a doctors appointment next Wednesday and am going to tell my doctor about my symptoms since I’ve been dealing with them since my freshman year of high school which was 13 years ago. I just don’t want her to think I’m making it up because I was just diagnosed with anxiety and before that it was depression and adhd. And I’ve been embarrassed to admit it. It’s just hard because I feel like I’m always getting diagnosed with something new.

[Selesnya in reply to Hidden]

OCD is not a very straight-forward problem. I know that my problems with depression were directly due to my OCD. I knew what depression was, and so I was trying to tackle that, but it ultimately wasn't that helpful on its own. It wasn't until I was in therapy with an OCD specialist that I really started to understand OCD and how it was really the root of all of my problems. I'm not saying that is the case with you, but being forthright about your symptoms is only going to help people figure out what is going on. If you doctor isn't super familiar with OCD, please, please try to find someone that knows what they are doing (and that knows ERP).

Good luck to you as you try to figure this out.

[Hidden in reply to Selesnya]

I feel like I’ve tried erp and cbt for months and no matter how hard I’ve tried the thoughts and urges are too great not to give into. And because I’ve been dealing with the ocd for so long I feel like my brain needs a little something to help it with calming the symptoms because I can’t do it on my own.

[Selesnya in reply to Hidden]

You can do it.

You need to start small, but it is important to find some tasks where you can resist the compulsions. I certainly agree that medication can help make things a little more manageable. If you always end up giving in to the compulsions then you are just torturing yourself for no gain. The "response prevention" part of ERP is crucially important. If you haven't gotten to that point yet then it is not a surprise that you are having a hard time. You may be meeting with a therapist, but you're not yet really doing ERP until you are preventing the responses.

I think that for a lot of us with OCD, we don't want to do the compulsions, but it feels like we have no choice. Not being able to follow our wishes and to be continually tortured by these thoughts leads to really negative self-talk, a lack of compassion for the genuinely hard time that you're going through, and quite possibly slipping into other mental health difficulties as well. It all ends up spiralling out of control and causing problems everywhere in our lives, but it is possible to reverse and fight back.

If you haven't looked at some of the great OCD resources in the resources threads, I would check out some of them.

[Hidden in reply to Selesnya]

It’s just hard because the voices in head are so loud when I try not o give into it. But they calm down when I give in.

[Hidden in reply to Selesnya]

So I take a shower everyday and wash my hair and it’s not one of those compulsions that are as strong as the other ones but since I do it everyday I think it may be classified as a compulsion. So could a small start be not washing my hair everyday or everytime I take a shower?

[Selesnya in reply to Hidden]

A compulsion would be something that you do in situations to calm down the anxiety or to avoid the anxiety from starting. You want to do something that is going to cause some anxiety, but not so much that it is overwhelming. Sometimes people might start off by writing some of their fears down on paper and carrying that around with them. It really depends on what causes you to get anxious, so I'm not really sure what to recommend. If not washing your hair will make you anxious, then that would be a good start.

Think of something that will make you anxious. What do you expect will happen when you engage in this activity? What are your responses likely to be? How can you resist your compulsions this time? What is an activity that you can do instead of your compulsions? It could be a task to focus on, singing a song, going for a run, paying attention to a TV show -- anything that keeps you focused someplace other than the anxiety. Let the anxiety just be there and do the activity anyways. If your focus slips back to the anxiety, remind yourself that you can do this and handle the anxiety and gently refocus back to your activity. At some point you're going to get on with your day and other things are going to happen. What was it like dealing with the anxiety? Was it as bad as you thought it would be? What did your body feel like? What were your urges in your body and how did you resist them?

Then it is just a lot of repetition and being gentle with yourself when you slip up and do the compulsions. Changing habits and responses is really hard work, but you can do it.

[Hidden in reply to Selesnya]

Well my biggest thing that causes me anxiety is fearing that I didn’t put on enough deodorant on. And so I started by only trying to put it on twice not over and over an over again. And I would tell myself it’s just the anxiety but everytime i did that the anxiety became too overwhelming and I had to give in and out more on. So, I guess I don’t know how I can start with something little with that situation and why I feel like I need some medicine to help control the thoughts in my head about it.

[Selesnya in reply to Hidden]

You don't have to start with the biggest thing that causes anxiety. Is there anything else that causes anxiety?

[Hidden in reply to Selesnya]

Well another one is I shave every day so maybe trying not shaving everyday. And I also have to do even number of things like how many times I put on deodorant, as well as having an even number of piercings. I also have to make sure the laces on my converse or shoes are exactly the same length as each other as well as making sure that when I make my bed my sheets are exactly perfectly even on each side to a tee and the lengths are exactly the same with each other on both sides.

[Selesnya in reply to Hidden]

This may be a bit beyond where you are right now, but I can't help but recommend listening to this podcast with Kimberley Quinlan and Reid Wilson:

kimberleyquinlan-lmft.com/e...

This is all where we want to get in our OCD recovery, but it can be a bit of a journey to get there.

[Hidden in reply to Selesnya]

I thought it was only for anxiety.

[Hidden in reply to Selesnya]

It’s just hard because when I try to put on not as much deodorant as I usually do my mind goes 100 miles an hour because if I don’t see the actual white part of the deodorant all over my underarms I feel like I didn’t put enough on and I have to check and recheck over again to show that I did put any on and that there’s enough and then I have to start smelling to make sure that it’s on because if I smell and my whole underarm doesn’t smell like the deodorant scent than I have to put more on because I’m afraid of the smell of sweat or how it stinks or smells even though I don’t do any sports and have never been one to sweat at all. And what happens is the more deodorant I put on the more wet my shirt gets from the deodorant because it’s not dry enough.

[Hidden in reply to Hidden]

And then when I don’t put as much on as I usually do it’ll feel dry but sticky at the same time especially if I only put it on once but then sometimes I’ll have that same feeling if I put it on twice.

[Selesnya in reply to Hidden]

It is hard. It is incredibly hard, but you can work at conquering it bit by bit. You really have to let yourself be anxious and be OK with that. If you're not ready for that yet, then you're not ready yet, and that's OK. You are allowed to be where you are in your recovery process.

[Hidden in reply to Selesnya]

I’m trying to be okay with being anxious but it’s hard the more I’m anxious the more fight at not checking, smelling or feeling to make sure I have enough deodorant on.

[Hidden in reply to Selesnya]

I mean when I start feeling anxious do I tell myself it’s okay if I sweat or smell or feel sticky from my deodorant and it’s okay if I didn’t put enough on? (I.E. I’ve never been a person to sweat at all or smell even though this is my biggest compulsion because I’ve been doing it for at least 10 years if not more)

[Hidden in reply to Selesnya]

And I also have a hard time not putting my arms up and letting them down because I’m afraid my deodorant will wipe off and I’ll sweat and i put them down they’ll get sticky or sweaty.

[Hidden in reply to Selesnya]

And I don’t know if my underarms get sticky because I put my deodorant on the same places over and over again. And I can’t tell if I put on the same place twice if that will happen or not. But when I’ve done it once they kind of smell and feel a little dry and sticky at the same time. And when I do it only twice they look kind of wet and a few times it i only do it once they still look a little wet but I don’t know if that’s just my ocd causing me to see stuff that may not be exactly true but my ocd is so strong that my mind is making me think it is.

[Hidden in reply to Selesnya]

And I really want to get over my ocd with deodorant because I’ve read that if you wear too much with aluminum it as a higher chance of causing cancer

[Hidden]

Well I feel like sometimes when I give into my ocd I feel more depressed because I jut can’t not give into it and more disappointed in myself. And I also believe that my anxiety also comes from it because I feel like I have to do my rituals or something bad is goin to happen.

[SpeakMyTruth]

Most agree a combination of meds and therapy is most effective, for exactly the purpose you're talking about. And it was absolutely so key in my case to. I was so disregulated from the ERP, I struggled to effectively engage in therapy (because I too, struggled for so long before being diagnosed and finding the right treatment). The meds help lower the shields a bit so therapy can get in there and work (and it does work!).

Definitely consult a psychiatrist, preferably one that has knowledge of OCD. If they're willing to work in conjunction with your therapist, even better.

[Hidden in reply to SpeakMyTruth]

Well I know my counselor can’t prescribe me the med. But i have a doctors appointment on Wednesday and I’m going to tell her all my symptoms and see if they send me to a psychiatrist or something like that and see what happens when I tell her that.

[Hidden]

I don’t know why but I’m getting anxiety about talking to my mom about how my ocd isn’t getting any better/ staying the same and getting worse at times. And telling her that when I go to my doctors appointment in Wednesday and all my symptoms and see if I can get a referral to a psychiatrist or someone who specializes specifically in ocd.

[Selesnya in reply to Hidden]

That's OK to get anxious. It's a situation where you don't know what is going to happen.

Try to make some goals for the day and work on those. I'm going to pick vegetables from my garden, do dishes and work on preparing a service for church. Try to just let the anxiety be there and go about with what you want to do. The anxiety doesn't have to be figured out.

[Hidden]

I meant get anxiety talking to my mom about it. I always get anxiety talking to my parents about situations especially about stuff with my mental health and ocd and my feelings.